Melanoma y embarazo

Traballo de Fin de Grao en Medicina. Curso 2019-2020.-Introducción: El melanoma (MM) es uno de los tumores malignos que más ha aumentado en las últimas décadas. Asimismo, se ha observado una mayor incidencia de melanoma en las mujeres. Teniendo en cuenta la tendencia actual de retrasar la maternidad y que la incidencia de MM aumenta en la tercera y cuarta décadas de la vida, no es poco frecuente que mujeres que han recibido un diagnóstico de melanoma tengan sus deseos genésicos sin completar. Durante años existió controversia en relación con el efecto potencialmente adverso de las hormonas femeninas asociadas al embarazo sobre el MM y los nevos melanocíticos. A día de hoy, sigue sin haber consenso respecto al tema y no disponemos de una evidencia lo suficientemente sólida sobre la influencia que puede tener el embarazo en el pronóstico de estas pacientes. - Objetivos: El objetivo de esta revisión sistemática es sintetizar la evidencia disponible sobre la influencia del embarazo posterior al diagnóstico de un melanoma en el pronóstico de éste. - Material y métodos: Hemos realizado una revisión sistemática en PubMed, Embase y Cochrane Library en la que se han incluido exclusivamente ensayos clínicos, estudios de cohortes y de casos y controles. Se ha evaluado el impacto del embarazo después del diagnóstico de melanoma en la supervivencia global, la supervivencia específica de melanoma y la supervivencia libre de enfermedad. También hemos evaluado si existe o no variación en el índice de Breslow y hemos intentado dar respuesta a si hay o no alteración en la historia natural de los nevos preexistentes. - Resultados: de los 944 artículos iniciales extraídos, seleccionamos finalmente cuatro artículos que cumplían los criterios de inclusión. Todos eran de cohortes retrospectivas, no aleatorizados, tres estudios poblacionales y uno desde una población hospitalaria. Los estudios revisados coinciden en que el embarazo no parece influir en un peor pronóstico en aquellas mujeres diagnosticadas con melanoma. No obstante, los datos de los que disponemos son escasos, muestran evidente heterogeneidad en los criterios de medición del pronóstico y se omite información potencialmente relevante como el estadio de la enfermedad al momento del diagnóstico o la existencia o no de cambios en nevos preexistentes. - Conclusiones: La evidencia actual no respalda la hipótesis de que el embarazo posterior al diagnóstico del melanoma empeore su pronóstico. Esperamos que futuros estudios permitan arrojar algo de luz ante un problema cada vez más frecuente.- Introdución: O melanoma (MM) é un dos tumores malignos que máis aumentou nas últimas décadas. Do mesmo xeito, observouse unha maior incidencia de melanoma nas mulleres. Tendo en conta que a tendencia actual é retrasar a maternidade e que a incidencia de MM aumenta na terceira e cuarta décadas da vida, non é pouco frecuente que mulleres que reciben un diagnóstico de melanoma teñan os seus desexos xenésicos sen completar. Durante anos existiu controversia en relación co efecto potencialmente adverso das hormonas femininas asociadas ao embarazo sobre o MM e os nevos melanocíticos. A día de hoxe, segue sen haber consenso respecto ao tema e non dispoñemos dunha evidencia o suficientemente sólida sobre a influencia que pode ter o embarazo no pronóstico destas pacientes. - Obxectivos: O obxectivo desta revisión sistemática é sintetizar a evidencia dispoñible sobre a influencia do embarazo posterior ao diagnóstico dun melanoma no pronóstico deste. - Material e métodos: Realizamos unha revisión sistemática en PubMed, Embase e Cochrane Library na que se incluiron exclusivamente ensaios clínicos, estudios de cohortes e de casos e controis. Evaluouse o impacto do embarazo despois do diagnóstico de melanoma na supervivencia global, na supervivencia específica de melanoma e na supervivencia libre de enfermidade. Tamén evaluamos se existiu ou non variación no índice de Breslow e intentamos dar resposta a se había ou non alteración na historia natural dos nevos preexistentes. - Resultados: dos 944 artigos iniciais extraídos, seleccionamos finalmente catro artigos que cumprían os nosos criterios de inclusión. Todos eran de cohortes retrospectivas, non aleatorizados, tres estudos poboacionais e un desde unha poboación hospitalaria. Os estudos revisados coinciden en que o embarazo non parece influir nun peor pronóstico naquelas mulleres diagnosticadas con melanoma. Non obstante, os datos dos que dispoñemos son escasos, amosan evidente heteroxeneidade nos criterios de medición do pronóstico e omítese información potencialmente relevante como o estadio da enfermedade ao momento do diagnóstico ou a existencia ou non de cambios en nevos preexistentes. - Conclusións: A evidencia actual non respalda a hipótese de que o embarazo posterior ao diagnóstico de melanoma empeore o seu pronóstico. Agardamos que futuros estudos permitan botar algo de luz ante un problema cada vez máis frecuente.- Introduction: Melanoma (MM) is one of the malignant tumors that has increased the most in recent decades. Likewise, a higher incidence of melanoma has been observed in women. Considering the current trend of delaying motherhood and that the incidence of MM increases in the third and fourth decades of life, it is not uncommon for women who have been diagnosed with melanoma to have their genesic desires incomplete. Over the years, there was controversy regarding the potentially adverse effect of pregnancy-related female hormones on MM and melanocytic nevi. Nowadays, there is still no consensus on the subject and we do not have strong evidence yet about the influence that pregnancy can have on the prognosis of these patients. - Objectives: The objective of this systematic review is to synthesize the available evidence on the influence of pregnancy after the diagnosis of melanoma on its prognosis. - Methods: We have conducted a systematic review on PubMed, Embase, and the Cochrane Library, exclusively including clinical trials, cohort studies, and case-control studies. The impact of pregnancy after melanoma diagnosis on overall survival, melanoma-specific survival, and disease-free survival has been evaluated. We have also evaluated whether or not there is variation in the Breslow index and we have tried to answer whether or not there is an alteration in the natural history of pre-existing nevus. - Results: Out of the 944 initial articles extracted, we finally selected four articles that met the inclusion criteria. All of them were from retrospective, non-randomized cohorts, three population studies and one from a hospital population. The reviewed studies agree that pregnancy does not seem to influence a worse prognosis in women diagnosed with melanoma. However, the data we have is scarce, shows evident heterogeneity in the prognostic measurement criteria and potentially relevant information such as the stage of the disease at diagnosis or the existence or not of changes in pre-existing nevus is omitted. - Conclusions: Current evidence does not support the hypothesis that pregnancy after melanoma diagnosis worsens its prognosis. We hope that future studies will shed some light on an increasingly frequent problem

Survival of women previously diagnosed of melanoma with subsequent pregnancy: a systematic review and meta-analysis and a single-center experience

Review[Abstract] Melanoma incidence has increased over the last few decades. How the prognosis of a previously diagnosed melanoma may be affected by a woman's subsequent pregnancy has been debated in the literature since the 1950s, and the outcomes are essential to women who are melanoma survivors in their childbearing years. The main objective of this systematic review is to improve the understanding of whether the course of melanoma in a woman may be altered by a subsequent pregnancy and to help clinicians' diagnosis. Eligible studies for the systematic review were clinical trials, observational cohort studies and case-control studies that compared prognosis outcomes for non-pregnant patients with melanoma, or pregnant before melanoma diagnosis, versus pregnant patients after a diagnosis of melanoma. The search strategy yielded 1101 articles, of which 4 met the inclusion criteria for the systematic review. All the studies were retrospective non-randomised cohorts with patients with melanomas diagnosed before pregnancy. According to our findings, a subsequent pregnancy was not a significant influence on the outcome of a previous melanoma. However, given the small number of identified studies and the heterogeneous data included, it is recommended to approach these patients with caution, and counselling should be given by known prognostic factors. We also reviewed the medical records of 84 patients of childbearing age (35.8 ± 6.3 years, range 21-45 years) who were diagnosed with cutaneous invasive melanoma in our hospital between 2008 and 2018 (N = 724). Of these, 11 (13.1%) had a pregnancy after melanoma diagnosis (age at pregnancy: 35.6 ± 6.3 years). No statistical differences in outcome were detected

Survival of Women Previously Diagnosed of Melanoma with Subsequent Pregnancy: A Systematic Review and Meta-Analysis and a Single-Center Experience

Melanoma incidence has increased over the last few decades. How the prognosis of a previously diagnosed melanoma may be affected by a woman's subsequent pregnancy has been debated in the literature since the 1950s, and the outcomes are essential to women who are melanoma survivors in their childbearing years. The main objective of this systematic review is to improve the understanding of whether the course of melanoma in a woman may be altered by a subsequent pregnancy and to help clinicians' diagnosis. Eligible studies for the systematic review were clinical trials, observational cohort studies and case-control studies that compared prognosis outcomes for non-pregnant patients with melanoma, or pregnant before melanoma diagnosis, versus pregnant patients after a diagnosis of melanoma. The search strategy yielded 1101 articles, of which 4 met the inclusion criteria for the systematic review. All the studies were retrospective non-randomised cohorts with patients with melanomas diagnosed before pregnancy. According to our findings, a subsequent pregnancy was not a significant influence on the outcome of a previous melanoma. However, given the small number of identified studies and the heterogeneous data included, it is recommended to approach these patients with caution, and counselling should be given by known prognostic factors. We also reviewed the medical records of 84 patients of childbearing age (35.8 +/- 6.3 years, range 21-45 years) who were diagnosed with cutaneous invasive melanoma in our hospital between 2008 and 2018 (N = 724). Of these, 11 (13.1%) had a pregnancy after melanoma diagnosis (age at pregnancy: 35.6 +/- 6.3 years). No statistical differences in outcome were detected

Guía de saúde infantil : actividades preventivas e de promoción da saúde en pediatría de atención primaria

Se trata de una guía de salud infantil dirigida a los profesionales que trabajan en el ámbito de la asistencia sanitaria a los niños y adolescentes en atención primaria del Sistema Público de Salud de Galicia.Trátase dunha guía de saúde infantil dirixida aos profesionais que traballan no ámbito da asistencia sanitaria aos nenos e adolescentes na atención primaria do Sistema Público de Saúde de Galicia

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass